Yoko Kashiwagi is a successful 42-year-old media executive, a graduate of Keio University who now lives in Denenchofu, just outside Tokyo, and works in Tsukiji downtown. Ms. Kashiwagi was a marathon runner in her college days, and continued to run and exercise regularly well into her 30s. But for the last five years her business responsibilities have prevented her from getting much exercise, and over the last two years she has stopped exercising altogether, has taken up smoking cigarettes, and has gained 7 or 8 kilos. Over the same period, she has been finding it increasingly more difficult to move her left knee, the same knee she injured during her running practice when she was in college.

Ms. Kashiwagi wants your advice because she is afraid that she might have rheumatoid arthritis or some other kind of arthritis. (She is familiar with complications from arthritis since her father, who was also an athlete, underwent ACL reconstruction surgery last year.) Ms. Kashiwagi tells you that she's been feeling more and more fatigued lately, and the crackling and stiffness in her left knee sometimes is very painful. In addition, she has noticed that her left knee gets swollen and red, especially when she has to work late into the night. Ms. Kashiwagi would like you to help her relieve her pain, and she also wants to know what her prognosis might be for the future.

She tells you that she will not undergo ACL surgery under any circumstances, but she also admits that she is afraid of becoming sicker. "In my business, a youthful and vigorous appearance is most important, and I'm frankly afraid of looking older than I am -- I'm only in my early 40s, after all!" Since Ms. Kashiwagi is unmarried, she is fearful of becoming much more isolated if her knee causes her much more trouble.

How you can
help:

Your work with Ms. Kashiwagi involves a good number of procedures. First, you need to determine what kind of additional information you'll need to properly determine the status of Ms. Kashiwagi's condition. For that reason, you'll want to review the data in the Knee Anatomy files, and in various Osteoarthritis files, including the files on Symptoms and Diagnosis. Second, Ms. Kashiwagi is afraid of what might happen in the future, and she is explicitly fearful of surgery, so you'll need to have her consider the alternatives. Data in the Treatments file should help you. Finally, if it is determined that Ms. Kashiwagi has osteoarthritis, she'll need to know what kind of adjustments she must make to live with her condition -- the file Living with Osteoarthritis will be invaluable in guiding you on how best to counsel Ms. Kashiwagi over the long term.

For now, you want to explain to Ms. Kashiwagi what the above three procedures entail, that is, you'll want to (1) tell her what kinds of data you'll need to give her a sound diagnosis; (2) summarize the likely forms of treatment she will require if she does have osteoarthritis as well as suggest specific things she can do now to relieve her condition; and (3) help her see how she can overcome her fears and sense of isolation in the future.